Care is the cornerstone of our practice

Visit our Location
101 OK-33, Perkins, OK 74059
Call or Text us!
(405) 547-1171
Send us a Message
cimchiro@outlook.com
Opening Hours
Mon - Sat 8:00 AM

New Patient Paperwork

  • Can be downloaded, printed and filled out prior to your appointment
  • Prior to your signature there is an option available if you would like text/email reminders and/or potential promotions sent to your device.
    Please make sure you give us permission to do so if you want these options.

 

Insurance/Cash Pay Breakdown

  • Includes a breakdown of estimated service pricing based on what needs to be done during your appointment and our office fee.
  • This is for both our uninsured patients as well as those with a deductible on their insurance.
  • This is information for you, you do not have to print it out!

 

Medicare Breakdown

  • Current 2023 annual deductible
  • Breakdown of potential charges
  • Estimated cost for our Medicare patients

 

Medicare Non-Covered Services

  • Including a list of services Medicare will not cover
  • Needs to be signed for acknowledgement as part of New/Return Patient Paperwork.